# HETLEVIA R JENSEN MD PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1710107529
- **Authorized official:** HETLEVIA R JENSEN MD (PHYSICIAN OWNER)
- **Authorized official phone:** (580) 225-2269

## Contact information

- **Practice address:** 1710 W 3RD ST, SUITE 103A, ELK CITY, OK 73644-5159
- **Practice address phone:** (580) 225-2269
- **Practice address fax:** (580) 225-1504
- **Mailing address:** 1710 W 3RD ST, SUITE 103A, ELK CITY, OK 73644-5159
- **Mailing address phone:** (580) 225-2269
- **Mailing address fax:** (580) 225-1504

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 23895 | OK | Yes |

## Other

- **Enumeration date:** 04/26/2007
- **Last updated:** 08/22/2020